AIMING DRY

The aim of this booklet is to give you more information about your bladder. Your doctor or nurse will have discussed your treatment plan with you. This booklet will allow you to keep a record of your progress. Please bring it along to each appointment with your nurse and then you can discuss any problems or question you may have.

YOU ARE NOT ALONE!

About three million people of all ages in Britain today, lose a degree of control of when and where they pass urine. Incontinence is the name given to this condition.
In many cases incontinence can be improved, it can often be cured. This booklet will explain about two of the most common types of incontinence and give you information of how you can help yourself.

STRESS INCONTINENCE

Stress Incontinence is very common in women and can affect one in four women at some stage in their lives. "Stress" does not mean that you have an emotional problem - it describes the physical effect when running, sneezing, coughing or laughing causes leakage of urine.
It can affect woman of all ages but it often starts during pregnancy, after childbirth or the menopause. The muscles in the pelvic floor which support the bladder and womb become weak and lose their tone. Sometimes no obvious cause of weakness can be discovered.
Stress Incontinence is rare in men but can happen after prostate operations. The problem is usually short term and pelvic floor exercises may help.

URGE SYNDROME

This means that you have a sudden need to pass urine but may be not able to reach the toilet in time. Sometimes the amount of urine maybe quite small, even though the bladder feels like it is bursting.
You may need to pass urine more often than usual (this is known as frequency). It is not uncommon to wake up several times in the night to pass urine, some people also wet the bed. It is usually caused by the bladder wall muscle becoming over active even though the bladder is not full. As people get older the bladder becomes more unpredictable and usually gives less warning and needs emptying more.
For many people the cause of an overactive bladder is unknown. A stroke or certain diseases of the nervous system can prevent the brain sending the right messages to the bladder to make it 'Hold On' until a toilet is reached.
It is quite common for some people to have both stress and urge incontinence.

TAKE TIME TO LOOK AFTER YOURSELF

Drink 6 to 8 glasses of water a day. Not drinking enough causes the urine to become very strong and concentrated and can increase the risk of a urine infection.. Cutting down on drinks will not stop you leaking.
Try to cut down on caffeine (tea, coffee, cola) as it can irritate the bladder.
Stop smoking. The nicotine in cigarettes irritates the lining of the bladder. Smoking causes you to cough, which may make you leak more.
Constipation can disturb how your bladder works. Eat a well balanced diet, which includes wholemeal foods, vegetables and pulses, these are good for preventing constipation. If you would like more advice about your bowels, please ask your nurse.
Exercise makes you feel, good. Keep as active and as mobile as you can.
Avoid being overweight. Getting down to your correct weight will reduce the amount of strain placed on the muscles and may make a considerable improvement in your symptoms.
Lifting puts a strain on the pelvic floor. If you need to lift a heavy object, bend at the knees and tighten your pelvic floor.

PELVIC FLOOR EXERCISES

THE BASIC EXERCISE

Imagine that you are trying to stop passing wind and at the same time trying to stop the flow of urine. The feeling is one of lifting and squeezing.
It is important to do this without…

Pulling in your tummy
Squeezing your legs together
Tightening your buttocks
Holding your breath!

In other words only the pelvic floor muscles should be working. This is called the "Secret Exercise", the exercise that no one can see you doing. This is called a PELVIC FLOOR CONTRACTION.

THE EXERCISE PROGRAMME

Tighten your pelvic floor muscles as just described, hold tight for as many seconds as you can (no more than 10 seconds). Then relax for 4 seconds

How long did you hold for?
Repeat this exercise, tighten, hold and relax (no more than 10 times)

How many times did you repeat the exercise?
This then becomes your 'Starting Block' e.g. …2... Seconds ...4... Repeats
Repeat your starting block as many times as you can throughout the day, every hour if you can.
As a result of this muscle training your pelvic floor will get stronger and your starting block will change. This means your muscles will be able to work harder for longer.
It is also important that your muscles are able to react quickly when, for example, you cough and sneeze.
Tighten and relax your pelvic floor (no more than 10 times). These are called quick contractions.

How many can you do at one Time?

Your exercise programme consists of.

1. Endurance - slow controlled exercises ('Starting Block')

Followed by:

2. Speed - short quick exercises.

It is helpful to keep a record of your progress:

Progress sheet for print out

That's the easy bit! The difficult part is remembering to do the exercises. Here are some tips to trigger your memory;

Do them each time you have a drink
Wear your watch on the wrong wrist
Exercise after you have emptied your bladder
Put stickers in places that will catch your eye, e.g. fridge, telephone, kettle.

For an occasional check to see how strong the muscles are becoming, try halting the flow of urine mid stream (but not if you have a urine infection). You can do this once every few weeks.
It may take 3-6 months to get good results. But persevere it will be worthwhile.

BLADDER RETRAINING

The aim of this treatment is to enable you to gain more control over your bladder.
The training will help your bladder slowly get used to stretching and holding onto more urine before giving you messages to empty it. This will reduce the chances of you leaking.
The chart you will have completed before coming to clinic will be able to show you how often you are going to the toilet and when you are having accidents. This chart will be used to set a baseline.
After discussion with your doctor or nurse, you will be able to agree a length of time that you can 'hold' for in-between each visit to the toilet, without leaving it until you have leaked.

What time have you agreed?…
On this time, you will commence your retraining programme. For example, if the length of time between going to the toilet is every hour, then you should go to the toilet every hour even if you don't feel the need to empty your bladder. You should not go to the toilet any sooner than the agreed time.
When you first commence the programme there will be sometimes when it will be difficult to wait until your planned time, but you must hold on ...

Think of something to distract you
Try sitting on a hard seat
Try to relax
Wear clothes that are loose and easy to manage
There will be some occasions when you may leak before planned time, wear some protection and still wait until it is

After a few days or a week (the time it takes is different with everyone you will find that you do not have the strong desire to empty your bladder when you reach your planned time, but are going to the toil (only because it is the time to go. This is Good! When comfortable with the time you are going, then you increase by 15 minutes. For example if you were going to the toilet every hour you now start to go every hour and 15 minutes.
At first this is as difficult as when you first began, but you will more comfortable as your bladder gets used to holding a little urine. When you become comfortable with the new time, then you increase the time again by another 15 minutes.
Each time, once you can manage comfortably to hold on, you increase the length of time between going to the toilet by 15 minutes. Your eventual aim is to be able to wait to go to the toilet for up to four hours.
Every section you increase will be a little bit different, you may find that it only takes you 3 days to hold for 2 hours but you may find it will take you 2 weeks to become comfortable when you set your time to 2 hours and 15 minutes, don't give in, stick with it.1
Don't worry about getting up in the night to empty your bladder. As you gain more control over your bladder during the day, the problems you have at night will improve.
It can be very inconvenient and limiting for you when doing the retraining, but the aim is to stop your bladder ruling your life. If you succeed with the programme, the time spent will not be wasted, imagine not having to know where the toilets are every time you go somewhere new, not worrying that the journey will be too long, no more accidents.

Remember:

Focus on your success and progress
Reward yourself as you progress
Have patience
Let some family and friends know what you are doing, they can be very supportive.

Keep a record of your progress. You can discuss any problems with your nurse or doctor at your next visit, or contact them sooner if you wish.

TABLETS

Some people may be prescribed tablets to take at the same time as they do the bladder retraining, your doctor or nurse will explain these in more detail if they are prescribed.